Illinois uninsured rate falls again -- but for how long?

Sept. 12--The number of people in Illinois without health insurance has dropped again -- though some worry that trend is about to reverse amid uncertainty over the future of Obamacare.

About 6.5 percent of Illinois residents -- or about 817,000 people -- were uninsured in 2016, according to the U.S. Census Bureau. That's a drop from the year before, when about 900,000 residents lacked insurance. It's also a big dip from 2013, before many provisions of the Affordable Care Act took effect, when 1.6 million people were uninsured.

The Affordable Care Act, also known as Obamacare, requires consumers to be insured or pay a penalty. The law also enabled Illinois and a number of other states to expand Medicaid, a state and federally funded insurance program for the poor. In addition, people may now shop for health insurance on exchanges, and they can't be denied coverage because of pre-existing conditions.

The law's supporters, however, fear the number of Illinois residents without coverage may soon increase again. In recent months, Congress has tussled over a number of plans to repeal and replace Obamacare, and the law's future remains unclear.

"From my perspective, the report makes clear that the Affordable Care Act is working, and particularly working for Illinois families," said Stephani Becker, a senior policy specialist at the Sargent Shriver National Center on Poverty Law. "I'm very concerned that our progress is going to be threatened ... by the Trump administration's campaign to sabotage the Affordable Care Act."

It's also unclear, even if the law remains in place, how strictly the Trump administration will enforce the requirement that all consumers be insured or face a penalty. Earlier this summer, after the Senate failed to pass a repeal bill, President Donald Trump tweeted "let ObamaCare implode, then deal."

The Trump administration already has announced that it plans to dramatically cut spending on efforts to promote open enrollment. The Centers for Medicare Medicaid Services plans to spend $10 million on those efforts, down from $100 million during the last open enrollment period.

Some doubt any of those issues will dramatically change the number of people without insurance.

Ed Haislmaier, a senior research fellow at the conservative Heritage Foundation, said sick people eligible for tax credits through the exchanges likely already are enrolled, and if healthy people haven't bought insurance, marketing efforts are unlikely to lure them in now.

"I don't see that marketing and advertising is going to bring in healthy people that haven't come in over the last three years," Haislmaier said.

Also, the requirement that everyone buy insurance or pay a penalty doesn't make much of a difference when it comes enticing more people to get covered, he said.

Haislmaier said most of the people who gained insurance did so after their states expanded Medicaid and since then, growth in insurance coverage has been relatively flat, according to insurers' regulatory filings, Medicaid and state data.

The real danger, he said, is keeping the Affordable Care Act in place. He worries that rising premiums on the exchange might inspire more people who aren't getting tax credits to forgo coverage.

Insurers on the exchange in Illinois proposed average rate increases last month ranging from 5 to 43 percent for next year.

Becker, on the other hand, worries that uncertainty surrounding whether insurers will continue getting subsidies from the federal government could have the same effect -- driving up premiums so that some people skip coverage.

Nationally, 8.6 percent of people were uninsured when interviewed as part of the American Community Survey last year, down from 9.4 percent the year before and 14.5 percent in 2013. Part of that increase in coverage nationally last year came from higher enrollment in Medicare, likely due to an aging population, according to the Census Bureau.

Texas had the highest uninsured rate in the nation last year at 16.6 percent and Massachusetts had the lowest at 2.5 percent.

States such as Illinois that expanded Medicaid tended to have lower uninsured rates than those that didn't, according to the census report.

lschencker@chicagotribune.com

List of Bills We're Following

Here are some bills we are working on. Be sure to check out our engagement list to find out how you can make a difference today.